Physicians' Perceptions of Barriers to Equal Access to Reproductive Health Promotion for Women with Mobility Impairment

Meera Joseph, Sujen Saravanabavan, Jeff Nisker

Abstract


In Canada, 15% of women report having a disability, most frequently mobility-related. Research with women with disabilities has for decades brought attention to barriers to reproductive health promotion. Research with physicians regarding why these barriers exist and how they can be dissolved has not occurred. Physicians were recruited through email and pamphlets to participate in 30-45 minute in-person interviews, audiotaped and transcribed verbatim.  Charmaz-based qualitative analysis was supported by NVivo10TM software. Twenty-five interviews were conducted before theoretical sufficiency. Six themes were co-constructed: I-Physicians’ Perceptions of Barriers; II-Physicians' Perceptions of Consequences of Barriers; III-Resolving Barriers; IV-Physicians’ Sub-Understanding of Legal Right to Accommodation; V-Obligation of Physicians to Advocate for Accommodation; and VI-Language Suggesting Physicians’ Lack of Understanding of How Persons with Disabilities See Themselves and Want to be Seen. Physicians identified physical access barriers previously identified in critical disability studies literature, but did not identify the barriers of physician attitudes and lack of information provision as reported in this literature. Physicians perceived their additional time for pap smears and other surveillance strategies as barriers, particularly when not remunerated. Physicians were unaware of their legal obligation to accommodate under human rights codes, perceiving that taking extra time to provide accommodation was doing so out of the "goodness of your heart". Physicians used language illustrating many were unaware of how disabled persons see themselves and want to be seen. Education regarding disability rights and culture must be introduced immediately and prominently into all levels of medical education, with the educators being people with disabilities. 


Keywords


Physicians' perceptions; mobility impairment; women's health; disability rights; medical education

Full Text:

PDF HTML

References


Asch, A., & Wasserman, D. (2010). Making Embryos Healthy or Making Healthy Embryos: How much of a difference between prenatal treatment and selection? In J. Nisker, F. Baylis, I. Karpin, C. McLeod, & R. Mykitiuk (Eds.), The "Healthy" Embryo: Social, biomedical, legal and philosophical perspectives (pp. 201-219). New York: Cambridge University Press.

Basson, R. (1998). Sexual health of women with disabilities. CMAJ., 159(4), 359-362.

Becker, H., Stuifbergen, A., & Tinkle, M. (1997). Reproductive health care experiences of women with physical disabilities: a qualitative study. Arch.Phys.Med Rehabil., 78(12 Suppl 5), S26-S33.

Beckmann, C. R., Gittler, M., Barzansky, B. M., & Beckmann, C. A. (1989). Gynecologic health care of women with disabilities. Obstet Gynecol, 74(1), 75-79.

Canadian Charter of Rights and Freedoms. (1982). Retrieved from http://laws-lois.justice.gc.ca/eng/Const/page-15.html

Canadian Human Rights Act, RSC 1985, c H-6. (1985). Retrieved from http://laws-lois.justice.gc.ca/eng/acts/H-6/index.html

Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks: Sage.

Chevarley, F. M., Thierry, J. M., Gill, C. J., Ryerson, A. B., & Nosek, M. A. (2006). Health, preventive health care, and health care access among women with disabilities in the 1994-1995 National Health Interview Survey, Supplement on Disability. Womens Health Issues, 16(6), 297-312.

Convention on the Rights of Persons with Disabilities (2006). Retrieved from https://www.un.org/development/desa/disabilities/resources/general-assembly/convention-on-the-rights-of-persons-with-disabilities-ares61106.html

Davis, L. (2002). Bending over Backwards: Disability, Dismodernism and Other Difficult Positions. New York: New York University Press.

Devlieger, P. J. (1999). From handicap to disability: language use and cultural meaning in the United States. Disabil.Rehabil., 21(7), 346-354.

Disability in Canada: Initial findings from the Canadian Survey on Disability. (2013). Retrieved from http://www.statcan.gc.ca/pub/89-654-x/89-654-x2013002-eng.htm

Fernald, C. D. (1995). When in London ...: differences in disability language preferences among English-speaking countries. Ment.Retard., 33(2), 99-103.

Frank, J. R. (2005). The CanMEDS 2005 Physician Competency Framework. Royal College of Physiciansand Surgeons of Canada.

Frank, J. R., Snell, L., & Sherbino, J. (2015). CanMEDS 2015 Physician Competency Framework. Royal College of Physiciansand Surgeons of Canada.

Frazee, C., Gilmour, J., & Mykitiuk, R. (2006). Now You See Her, Now You Don't': How Law Shapes Disabled Women's Experience of Exposure, Surveillance, and Assessment in the Clinical Encounter". In D. Pothier & R. Devlin (Eds.), Critical Disability Theory: Essays in Philosophy, Politics, Policy and Law (pp. 223-247). Vancouver: University of British Columbia Press.

Frazee, C., Gilmour, J., Mykitiuk, R., & Bach, M. (2002). The legal regulation and construction of the gendered body and of disability in Canadian health law and policy. National Network on Environments and Women's Health. Retrieved from http://www.cwhn.ca/en/node/24745

Gibson, B. E., & Mykitiuk, R. (2012). Health care access and support for disabled women in Canada: falling short of the UN Convention on the Rights of Persons with Disabilities: a qualitative study. Womens Health Issues, 22(1), e111-e118.

Human Rights Code, RSO 1990, c H.19, (1990).

Iezzoni, L. I., McCarthy, E. P., Davis, R. B., Harris-David, L., & O'Day, B. (2001). Use of screening and preventive services among women with disabilities. Am J Med Qual, 16(4), 135-144.

Iezzoni, L. I., McCarthy, E. P., Davis, R. B., & Siebens, H. (2000). Mobility impairments and use of screening and preventive services. Am J Public Health, 90(6), 955-961.

Kallianes, V., & Rubenfeld, P. (1997). Disabled women and reproductive rights. Disability & Society, 12(2), 203-222.

Kroll, T., Jones, G. C., Kehn, M., & Neri, M. T. (2006). Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry. Health Soc Care Community, 14(4), 284-293.

Leach Scully, J. (2008). Disability Bioethics Moral Bodies, Moral Difference: Rowman & Littlefield Publishers.

Leach Scully, J. (2009). Towards a bioethics of disability and impairment. In P. Atkinson, P. Glasner, & M. Lock (Eds.), Handbook of Genetics and Society: Mapping the new genomic era (pp. 367-381). London: Routledge.

Linton, S. (1998). Claiming Disability: Knowledge and Identity. New York: New York University Press.

Lynch, R. T., & Groombridge, L. (1994). Person-first disability language: A pilot analysis of public perceptions. Journal of Rehabilitation, 60(2), 18.

Mele, N., Archer, J., & Pusch, B. D. (2005). Access to breast cancer screening services for women with disabilities. J Obstet Gynecol Neonatal Nurs., 34(4), 453-464.

Mykitiuk, R., Chaplick, A., & Rice, C. (2015). Beyond normative ethics: Ethics of arts-based disability research. Ethics, Medicine and Public Health, 1(3), 373-382.

Mykitiuk, R., & Karpin, I. (2016). Fit or Fitting In: Deciding Against Normal When Reproducing the Future. Normalcy and Disability: Intersections Among Norms, Law and Culture.

Mykitiuk, R., & Nisker, J. (2010). Social determinants of "health" of embryos. In J. Nisker, F. Baylis, I. Karpin, C. McLeod, & R. Mykitiuk (Eds.), The "healthy" embryo: Social, biomedical, legal and philosophical perspectives (pp. 116-135). New York: Cambridge University Press.

Nisker, J. (2001). Orchids: Not Necessarily A Gospel. In J. Murray (Ed.), Mappa Mundi: Mapping Culture/Mapping the World (pp. 61-110). Windsor, ON: University of Windsor Press.

Nisker, J. (2010). Calcedonies: critical reflections on writing plays to engage citizens in health and social policy development. Reflective Practice: International and Multidisciplinary Perspectives, 11(4), 417-432.

Nisker, J. (2012). From Calcedonies to Orchids: Plays Promoting Humanity in Health Policy. Toronto; Ontario: Iguana Press.

Nisker, J. (2013). Calcedonies. In T. Jones, L. Friedman, & D. Wear (Eds.), Health and Humanities Reader: Rutgers University Press.

Nisker, J. (2015a). The Latest Thorn by Any Other Name: Germ-Line Nuclear Transfer in the Name of "Mitochondrial Replacement". J Obstet Gynaecol Can, 37(9), 829-831.

Nisker, J. (2015b). Patiently Waiting For... Toronto, ON: Iguana Books.

Nosek, M. A., Hughes, R. B., Howland, C. A., Young, M. E., Mullen, P. D., & Shelton, M. L. (2004). The meaning of health for women with physical disabilities: a qualitative analysis. Fam Community Health, 27(1), 6-21.

Nosek, M. A., Young, M. E., Rintala, D. H., Howland, C. A., Foley, C. C., & Bennett, J. L. (1995). Barriers to reproductive health maintenance among women with physical disabilities. Journal of Women's Health, 4(5), 505-518.

Odette, F., Yoshida, K. K., Israel, P., Li, A., Ullman, D., Colontonio, A., . . . Locker, D. (2003). Barriers to wellness activities for Canadian women with physical disabilities. Health Care Women Int., 24(2), 125-134.

Oliver, M. (1990). The Politics of Disablement: A Sociological Approach. New York, NY: St. Martin's Press, Inc.

Parens, E., & Asch, A. (2000). Prenatal Testing and Disability Rights. Washington, DC: Georgetown University Press.

Rice, C. (2012). Project Re-Vision. Retrieved from https://projectrevision.ca/

Rice, C., Chandler, E., Rinaldi, J., Changfoot, N., Liddiard, K., Mykitiuk, R., & Mündel, I. (2017). Imagining Disability Futurities. In Hypatia

Richardson, L. (2000). Writing: A Method of Inquiry. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of Qualitative Research (2 ed., pp. 923-948). Thousand Oaks, CA: Sage Publications Inc.

Roetzheim, R. G., & Chirikos, T. N. (2002). Breast cancer detection and outcomes in a disability beneficiary population. J Health Care Poor Underserved, 13(4), 461-476.

Shakespeare, T. (2000). Disabled sexuality: toward rights and recognition. Sexuality and Disability, 18(3), 159-166.

Shakespeare, T. (2005). The social context of individual choice. In D. Wasserman, J. Bickenbach, & R. Wachbroit (Eds.), Quality of Life and Human Difference: Genetic Testing, health Care, and Disability (pp. 217-236). Cambridge: Cambridge University Press.

Shakespeare, T. (2006). Disability Rights and Wrongs. New York: Routledge.

Shakespeare, T. (2014). Disability Rights and Wrongs Revisited (2 ed.). New York, NY: Routledge.

Shakespeare, T. (2016). Just What Is the Disability Perspective on Disability? Hastings Cent Rep, 46(3), 31-32. doi:10.1002/hast.587

Smeltzer, S. C., Sharts-Hopko, N. C., Ott, B. B., Zimmerman, V., & Duffin, J. (2007). Perspectives of women with disabilities on reaching those who are hard to reach. J Neurosci.Nurs., 39(3), 163-171.

Strauss, A., & Corbin, J. (1998). Basics of qualitative research. Thousands Oaks, CA: Sage Publications.

Taylor, K., & Mykitiuk, R. (2001). Genetics" Normalcy and Disability. Isuma Canadian Journal of Policy Research, 2(3), 65-71.

Thomas, C. (2007). Sociologies of Disability and Illness: Contested Ideas in Disability Studies and Medical Sociology. Basingstoke, UK: Palgrave Macmillian.

Vanstone, M., King, C., deVrijer, B., & Nisker, J. (2014). Non-invasive prenatal testing: ethics and policy considerations. J Obstet Gynaecol Can, 36(6), 515-526.

Wasserman, D., Bickenbach, J., & Wachbroit, R. (2005). Quality of Life and Human Difference: Genetic Testing, Health Care, and Disability. Cambridge: Cambridge University Press.

Whelner, S. L. (1997). Gynecologic care and sexuality issues for woemn with disabilities. Sexuality and Disability, 15, 33-40.

Yankaskas, B. C., Dickens, P., Bowling, J. M., Jarman, M. P., Luken, K., Salisbury, K., . . . Lorenz, C. E. (2010). Barriers to adherence to screening mammography among women with disabilities. Am.J Public Health, 100(5), 947-953.




DOI: http://dx.doi.org/10.15353/cjds.v7i1.403

Refbacks

  • There are currently no refbacks.




 

The Canadian Journal of Disability Studies is Published by the Canadian Disability Studies Association-Association Canadienne des Études sur l'Incapacité, and is hosted and supported by the University of Waterloo.

ISSN 1929-9192 Canadian Journal of Disability Studies (Online)